【作者】 陈林；

【导师】 吴节；

【作者基本信息】 成都中医药大学 ， 针灸推拿学， 2015， 硕士

【摘要】 目的：本研究采用安神补肾针灸法改善脾肾阳虚型黄体功能不全(LPD)患者的子宫内膜容受性,从而改善临床症状,降低流产率,提高受孕率,改善妊娠结局,缓解因LPD而导致的生育危机,为针灸治疗LPD提供新思路、新方法。方法：采用随机、对照的方法,将符合纳入诊断的60例脾肾阳虚型LPD的受试者分为治疗组和对照组。治疗组采用安神补肾针灸疗法治疗,隔日治疗1次,一个月经周期为1个疗程,对照组采用中药治疗。治疗疗程均为3个月经周期,治疗结束后第1个月经周期随访一次。观察治疗前后两组经阴道彩超下监测黄体中期子宫动脉血流参数(PI、RI)、内膜类型、内膜厚度、BBT类型、BBT高温相评分(HPS)、黄体中期血清孕酮值及中医症候积分改善情况及不良反应情况,做出疗效及安全性评价。结果：(1)基线分析：治疗前两组患者年龄、生育情况、病程等基线资料相比较,经统计学分析均无显著性差异(P>0.05),说明两组资料分组均衡,具有可比性。(2)治疗前两组间黄体中期子宫动脉血流参数(PI、RI)、内膜类型、内膜厚度、BBT类型、BBT高温相评分(HPS)、黄体中期血清孕酮值、脾肾阳虚症状积分相比较,经统计学分析均无显著性差异(P>0.05),提示两组具有可比性。(3)两组间疾病疗效比较：治疗组总有效率为89.66%,对照组总有效率为86.21%,差异无统计学意义(P>0.05),提示两组治疗总有效率相似。(4)治疗后主要指标改善情况：①两组治疗前后自身对照：治疗组及对照组自身治疗前后黄体中期子宫动脉血流参数(PI、RI)、内膜类型、内膜厚度、BBT类型、BBT高温相评分(HPS)、黄体中期血清孕酮值及中医症候积分比较,均具有统计学差异(P<0.05),提示两组治疗均有效。②治疗后治疗组在黄体中期子宫动脉血流参数(PI、RI)、内膜类型、BBT类型、BBT高温相评分(HPS)方面与对照组相比较差异均具统计学意义(P<0.05),提示安神补肾针灸疗法能综合改善子宫内膜容受性相关指标。(5)随访：①两组治疗前与随访时自身对照：黄体中期子宫动脉血流参数(PI、RI)、内膜形态、内膜厚度、BBT类型、BBT高温相评分(HPS)、黄体中期血清孕酮值及中医症候积分比较,均具有统计学差异(P<0.05),提示两组治疗均有后续效应。②随访时两组组间对照：黄体中期子宫动脉血流参数(PI、RI)、BBT类型及BBT高温相评分(HPS)比较,差异有统计学意义(P<0.05),提示治疗组以上方面后续效应优于对照组。结论：安神补肾针灸法与中药治疗在改善黄体中期子宫动脉血流参数(PI、RI)、BBT类型、BBT高温相评分(HPS)、内膜厚度、内膜类型、黄体中期血清孕酮值及脾肾阳虚症状方面均有较好的临床疗效,两组治疗总有效率相似。治疗组在改善患者黄体中期子宫动脉血流参数(PI、RI)、BBT类型及BBT高温相评分(HPS)方面优于中药组,从而可以改善子宫内膜容受性,提高LPD患者妊娠率。提示安神补肾针灸疗法对改善脾肾阳虚型LPD患者子宫内膜容受性有较好的疗效。且安全、副作用少,值得临床推广。更多还原

【Abstract】 Aim:This research is a study of the efficacy of tranquillization and tonifying kidney acupuncture and moxibustion on improving endometrial receptivity of luteal phase deficiency(LPD) induced spleen-kidney yang deficiency,to improve the clinical symptoms,increase the pregnancy rate, reduce the abortion rate,reduce the fertility crisis caused by the LPD,to provide new ideas and methods of treatment on LPD by acupuncture and moxibustion.Methods:Under the methods of randomized,controlled,60 cases of LPD induced spleen and kidney yang deficiency will be decided into a treatment group and a control group,the treatment group received tranquillization and tonifying kidney acupuncture and moxibustion on alternate day,a menstrual cycle as a course of treatment,the control group using traditional chinese medicine treatment.Both of the two groups get three menstrual cycles.Ended all the treatment both groups were be observed after a menstrual cycle,including uterine artery blood (PI, RI) under transvaginal ultrasound of mid-luteal, endometrial type,endometrial thickness,BBT type,HPS,the mid-luteal progesterone TCM symptom score and side-effection,make the rapeutic effect and safety evaluation.Results:(1)Baseline analysis:Before treatment, the patient’s age,childbearing situation, the course of the disease,the statistical analysis showed no significant difference (P> 0.05), described two sets of data grouping balanced comparable.(2)Before treatment,uterine artery blood (PI, RI), endometrial type,endometrial thickness,BBT type,HPS,the mid-luteal progesterone TCM symptom score,the statistical analysis showed no significant difference (P>0.05), described two sets of data grouping balanced comparable.(3)Comparison of effects:the treatment group was 89.66%; the control group was 86.21%. the statistical analysis showed no significant difference (P>0.05), Prompt the total effective rate of two groups is similar.(4)After treatment:①Pre-treatment and post-treatment indices within each group:uterine artery blood (PI, RI), endometrial type,endometrial thickness,BBT type,HPS,the mid-luteal progesterone TCM symptom score haved changed before and after treatment,proves to be statistically significant (p<0.05),which indicates that both treatments are effective.②Comparison in uterine artery blood (PI,RI),endometrial type,BBT type,HPS,treatment group proves to be statistically significant (p<0.05),which indicates that tranquillization and tonifying kidney acupuncture and moxibustion can improve the receptivity of endometrial.(5)Follow-up study:①Pre-treatment and follow-up comparison within each group:uterine artery blood (PI, RI), endometrial type,endometrial thickness,BBT type,HPS,the mid-luteal progesterone TCM symptom score had changed at pre-treatment and follow-up,proves to be statistically significant (p<0.05),prompts a subsequent effect of the two treatments.)②Pre-treatment and follow up comparison between groups:the change of uterine artery blood (PI, RI),BBT type and HPS are proved to be statistically significant (p< 0.05)in the treatment group,prompt the treatment group is better than the control group in the follow-up effect.Conclusion:The two methods have good clinical curative effect and similar effective rate at improve the uterine artery blood(PI,RT), endometrial type,endometrial thickness,BBT type,HPS,the mid-luteal progesterone TCM symptom score, in improving uterine artery blood (PI, RI),BBT type,HPS,the treatment group is superior to the traditional chinese medicine group,which can better improved the endometrial receptivity and the pregnancy rate of LPD patients.also to be safety and less side effects, it is worth to promote to clinical.更多还原